Introduction We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. Patients and methods We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. Results We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay ( P =  .002; 95% CI, 4.032-6.022; OR:). Conclusions Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.

Highlights After severe SARS-CoV2 infection, radiological abnormalities such as encephalopathies may be seen. An extensive radiological encephalopathy may not correlate with abnormalities in cerebrospinal fluid. An extensive radiological encephalopathy does not correlate with the severity of symptoms.

Introducción Nos proponemos analizar las complicaciones neurológicas de los pacientes con infección grave por SARS-CoV-2 que han requerido ingreso en unidad de cuidados intensivos (UCI). Pacientes y métodos Estudio descriptivo retrospectivo, observacional, de pacientes consecutivos ingresados en UCI por infección respiratoria grave por SARS-CoV-2 desde el 1 de abril hasta el 1 de junio de 2020. Resultados Registramos 30 pacientes con síntomas neurológicos, 21 hombres (72,40%), edad media: 57,41 años ± 11,61 desviación estándar (DE). Estancia media en UCI: 18,83 ± 14,33 DE. A nivel sindrómico: 28 pacientes (93,33%) con síndrome confusional agudo, 15 (50%) con patología neuromuscular, 5 (16,66%) con cefalea, 4 (13,33%) con patología cerebrovascular y 4 (13,33%) con encefalopatías/encefalitis. Punción lumbar normal en 6 pacientes (20%). La RMN craneal o TAC craneal mostró alteraciones en 20 casos (66,6%). Se realizó EEG en todos los pacientes (100%), alterado en 8 pacientes (26,66%). En 5 de los 15 pacientes con miopatía clínica se ha podido confirmar con ENMG. Hemos encontrado relación entre la mayor edad y los días de ingreso en UCI (p = 0,002; IC 95%: 4,032-6,022; OR: 3,594). Conclusiones La infección grave por COVID-19 afecta mayoritariamente a hombres, similar a lo descrito en otras series. La mitad de nuestros pacientes presenta una miopatía aguda, y casi la totalidad de los pacientes salen de la UCI con síndromes confusionales agudos que evolucionan a una resolución completa, sin correlacionarse con los resultados del EEG o de pruebas de neuroimagen. La mayor edad se asocia con un mayor número de días de estancia en UCI.

BackgroundTo identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse).MethodsA qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each “do not do” (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist.ResultsIn total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care.ConclusionOveruse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.

Objectives: Myotonic dystrophy type 1 (DM1) is characterized by multisystemic effects that include frequent respiratory impairment that can affect prognosis. Despite this, there are not many studies specifically evaluating such alterations and no one from Spain. The aim of this study is to evaluate respiratory impairment in a Spanish group of patients with DM1. Materials and methods: Respiratory data were systematically collected from all patients with DM1 referred to a pulmonary clinic between June 2009 and June 2016. All patients completed the Epworth Sleepiness Scale and underwent forced spirometry test, cardiorespiratory polygraphy and blood gas analysis. Results: 44 patients were evaluated. 21 (48%) had a ventilatory impairment. 14 (31%) had hypoxemia, 2 (4%) respiratory failure and 14 (31%) hypercapnia. 39 (87%) had obstructive sleep apnoea, 40% being severe, and 18 (40%) showed nocturnal hypoventilation. A relationship between ventilatory impairment and blood gas alterations was found. It was found a relationship between ventilatory impairment and OSA. 31 (69%) were treated with a respiratory device. Adherence was poor. Conclusions: In this cohort of patients, the prevalence of ventilatory impairment and sleep breathing disorders were high. A careful respiratory evaluation, including assessment of sleep breathing, is advisable in patients with DM-1.